珊瑚人工骨桥应用于颈椎后路椎管扩大成形术的临床研究  

Cervical posterior laminoplasty operation using coralline hydroxyapatite

作　　者：刘波[1] 田伟[1] 王永庆[1] 李勤[1] 胡临[1] 李志宇[1] 袁强[1] 

机构地区：[1]北京积水潭医院脊柱外科,100035

出　　处：《中华外科杂志》2005年第12期766-769,共4页Chinese Journal of Surgery

摘　　要：目的探讨将珊瑚人工骨(CHA)应用于颈椎后路椎管扩大成形术的效果。方法从1995年8月至2003年12月256例患者行棘突纵割式椎管扩大成形术。对所有的患者行3个月以上随访,平均随访时间为35个月。所有患者均为3个节段以上的广泛椎管狭窄或颈椎后纵韧带骨化。对所有患者做术前、术后的JOA评分,行X线摄片,观察颈椎的序列和活动变化。96例患者在末次随访时行棘突部位的CT扫描共480节段,观察人工骨与自体骨愈合情况。82例患者末次随访时行MRI检查。观察脊髓受压的改善情况。结果临床评分:手术前平均JOA评分7.25分,手术后平均9.20分,末次随访时平均11.48分,平均改善率为58.3%。颈椎曲度:手术前平均19.5°,手术后3个月随访时15.6°,末次随访时平均19.2°,人工骨桥稳定,人工骨融合率为83.5%。手术后MRI检查显示:脊髓明显后移,脊髓扁平率从手术前0.19达到手术后的0.42。随访时未见明显的颈椎后凸畸形;24例患者有轴性疼痛。结论珊瑚人工骨应用于颈椎后路椎管扩大成形术具有良好的效果。Objective To study the results of using coralline hydroxyapatite (CHA) in cervical posterior laminoplasty operation. Methods Two hundred and fifty-six patients underwent cervical spinous process-splitting laminoplasty using CHA. All patients had been followed up over 3 months. One hundred and forty-two patients were followed up at least 2 years. All patients had spinal stenosis at least at 3 levels or OPLL. The average follow up time was 34.6 months. Results The CHA grafts were stable between the split spinous processes. The union rate of CHA was 83.5%. After operation, the spinal cord moved dorsally, and the anteroposterior compression ratio had been improved from 0.19 to 0.42. No apparent kyphosis occurred .The JOA score improvement rate was 58.3%. There were 24 patients (17%) with axial symptom. Conclusion Cervical posterior laminoplasty operation using coralline hydroxyapatite may achieve good results.

关 键 词：颈椎后路椎管扩大成形术 临床研究 骨桥 纵割式椎管扩大成形术 颈椎后纵韧带骨化 珊瑚人工骨 JOA评分 MRI检查 颈椎后凸畸形 2003年 1995年 手术后 手术前 随访时间 椎管狭窄 X线摄片 CT扫描 愈合情况 改善情况 脊髓受压 

分 类 号：R687.3[医药卫生—骨科学]